New study on surgery for seniors in the last year of life

There are many things wrong with this study on surgeries done on seniors in the last year of life. The author of this Time article notes one such problem;"[R]esearchers looked only at surgery patients who died; it's not known how many patients who had the same procedure survived."Another problem is that while documenting the number of surgeries in the last 12 months of life, the researchers failed to collate what kind of surgeries were performed and why. There must be many, many instances of a surgery being performed on someone where there is no hint of their imminent demise. Doctors aren't soothsayers and asking them to project outcomes 3, 6, or 12 months in advance is ridiculous.

But there is some value to this study:

Of the 1.8 million Medicare patients over age 65 who died in 2008, researchers found that a third had undergone surgery in the year before death and that 18% of those surgeries had occurred in the month before death. Nearly 1 in 10 had surgery in their final week. The numbers were surprisingly high, researchers said.

To some extent, the finding makes sense: sick people have surgery and sick people also die. But while the researchers did not examine whether individual surgeries were necessary or whether they improved patients' quality of life - many surely did - the data suggested they did not improve outcomes overall. Areas of the country that had high rates of surgery also had high rates of death.

This will no doubt fuel the debate over "outcomes" versus "care" that currently roils the conversation over Medicare spending. If someone is in the last stages of a terminal illnes, should they get a hip replacement? These are not inconsequential questions that can easily be answered. I wrote about the issues involved after a "60 Minutes" segment on end of life care:

How much do we, as a society, value individual life? At what point does what's good for the many outweigh what's good for the one? Should anyone - insurance companies, government, or a "death panel" - have the right to tell a patient and their family when it is time to let go of life and allow the natural progression of their disease to kill them?

All of these questions and more like it are asked with the costs associated with end of life treatment always in the background. And it isn't just the costs. It is the tremendous amount of health care resources devoted to people who have no hope of recovery...

Of course, there should be little debate that involves palliative care to ease a patient's suffering. And no one is asking for the terminally ill to be dumped in a hospice and allowed to die without being cared for (although there are some shocking examples of criminally negligent hospices that are like that).

Modern science and technology have combined to create dillemas for doctors, for families, and for medical ethicists in the treatment of the terminally ill. The question that conservatives keep asking is will these decisions remain between a family and the patient's physician? Or will government and their "outcomes" based math prevail?

There are many things wrong with this study on surgeries done on seniors in the last year of life. The author of this Time article notes one such problem;"[R]esearchers looked only at surgery patients who died; it's not known how many patients who had the same procedure survived."

Another problem is that while documenting the number of surgeries in the last 12 months of life, the researchers failed to collate what kind of surgeries were performed and why. There must be many, many instances of a surgery being performed on someone where there is no hint of their imminent demise. Doctors aren't soothsayers and asking them to project outcomes 3, 6, or 12 months in advance is ridiculous.

But there is some value to this study:

Of the 1.8 million Medicare patients over age 65 who died in 2008, researchers found that a third had undergone surgery in the year before death and that 18% of those surgeries had occurred in the month before death. Nearly 1 in 10 had surgery in their final week. The numbers were surprisingly high, researchers said.

To some extent, the finding makes sense: sick people have surgery and sick people also die. But while the researchers did not examine whether individual surgeries were necessary or whether they improved patients' quality of life - many surely did - the data suggested they did not improve outcomes overall. Areas of the country that had high rates of surgery also had high rates of death.

This will no doubt fuel the debate over "outcomes" versus "care" that currently roils the conversation over Medicare spending. If someone is in the last stages of a terminal illnes, should they get a hip replacement? These are not inconsequential questions that can easily be answered. I wrote about the issues involved after a "60 Minutes" segment on end of life care:

How much do we, as a society, value individual life? At what point does what's good for the many outweigh what's good for the one? Should anyone - insurance companies, government, or a "death panel" - have the right to tell a patient and their family when it is time to let go of life and allow the natural progression of their disease to kill them?

All of these questions and more like it are asked with the costs associated with end of life treatment always in the background. And it isn't just the costs. It is the tremendous amount of health care resources devoted to people who have no hope of recovery...

Of course, there should be little debate that involves palliative care to ease a patient's suffering. And no one is asking for the terminally ill to be dumped in a hospice and allowed to die without being cared for (although there are some shocking examples of criminally negligent hospices that are like that).

Modern science and technology have combined to create dillemas for doctors, for families, and for medical ethicists in the treatment of the terminally ill. The question that conservatives keep asking is will these decisions remain between a family and the patient's physician? Or will government and their "outcomes" based math prevail?